Respiratory Clinical

Question 1

What chromosome is the mutation on in alpha 1 anti trypsin deficiency?

Answer 1

14

Question 2

How is alpha 1 anti tryspin deficiency inherited?

Answer 2

Autosomal recessive/co dominant fashion.

Question 3

What do they different alleles mean in alpha 1 antitrypsin deficiency?

Answer 3

M Normal
S Slow
Z Very slow

Question 4

What type of hypersensitivity is seen in extrinsic allergic alveolitis?

Answer 4

Type 3 (immune complex mediated tissue damage) 
Type 4 (Delayed) can also play a role - especially in the chronic phase.

Question 5

What causes bird fanciers lung?

Answer 5

Avian proteins from bird droppings

Question 6

What causes farmers lung?

Answer 6

Saccharopolyspora rectivirgula from wet hay

Question 7

What causes malt workers lung?

Answer 7

Aspergillus clavatus

Question 8

Where in the lungs is the fibrosis in extrinsic allergic alveollitis?

Answer 8

Upper/mid zones

Question 9

What is the management of extrinsic allergic alveolitis?

Answer 9

Avoid precipitating factors

Oral glucocorticoids

Question 10

What is lofgrens syndrome?

Answer 10

An acute form of sarcoidosis characterised by bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia. It typically accurs in young females and has an excellent prognosis.

Question 11

What features are associated with small cell lung cancer?

Answer 11

Ectopic ADH and ACTH secretion (resulting in hyponatremua and cushings syndrome)
Lambert eaton syndrome

Question 12

What medications can precipitate churg strauss (eosinophillic granulomatosis with polyangitis)?

Answer 12

Montelukast

Question 13

What is lights criteria for exudative effusion?

Answer 13

Require one or more of the following:
1. Pleural fluid protein/Serum protein > 0.5
2. Pleural fluid LDH/Serum LDH > 0.6
3.

Question 14

What is bronchiectasis?

Answer 14

Permanent dilatation of the airways secondary to chronic inflammation or infection

Question 15

What are the causes of bronchiectasis?

Answer 15

Post infective - TB, measles, pertussis, pneumonia
Cystic fibrosis 
Bronchioal obstruction 
Immune deficiency 
Allergic bronchopulmonary aspergillosis 
Kartageners sydrome 
Youngs syndrome 
Yellow nail sydrome

Question 16

What is allergic bronchopulmonary aspergillosis? What are the main symptoms?

Answer 16

Results from an alllergy to aspergillus spores.
Main features are bronchoconstriction, bronchiectasis.

Eosinophillia, positive RAST, Raised IgE

Question 17

What is the treatment for allergic bronchopulmonary aspergillosis?

Answer 17

Oral glucocorticoids

Question 18

What is the criteria for long term oxygen in patients with COPD?

Answer 18

p02 less than 7.3 on two blood gases at least 3 weeks apart in a patient on optimal managment,

p02 7.3 - 8 plus one of the following

1. Secondary polycythaemia
2. Peripheral oedema
3. Pulmonary hypertension

Question 19

What is the transfer factor?

Answer 19

The rate at which a gas will diffuse from alveoli into blood. Carbon monoxide is used to test the rate of diffusion. Results can be given as the total gas transfer (TLCO) or that corrected for lung volume (transfer coefficient, KCO)

Question 20

What causes a raised TLCO?

Answer 20

Asthma
Pulmonary haemmorhage 
Left to right cardiac shunts 
Polycythemia 
Hyperkinestic states 
male gender 
exercise

Question 21

What causes a low TLCO?

Answer 21

Pulmonary fibrosis
Pneumonia 
PE 
Pulmonary oedema 
Emphysema 
Low cardiac output

Question 22

What are the key indications for NIV?

Answer 22

COPD with respiratory acidosis pH 7.25 to 7.35
Type 2 respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation

Question 23

What is the criteria for acute respiratory distress syndrome?

Answer 23

Acute onset (within 1 week of known risk factor)
pulomary oedmea: Bilateral infiltrates on CXR
Non cardiogenic
P 02 <40kpa